Provider Demographics
NPI:1881797686
Name:FERNANDEZ, LUIS BELTRAN (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:BELTRAN
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 VANDERBILT AVE # PH
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1505
Mailing Address - Country:US
Mailing Address - Phone:718-399-3498
Mailing Address - Fax:718-963-5800
Practice Address - Street 1:414 VANDERBILT AVE PH
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1505
Practice Address - Country:US
Practice Address - Phone:718-399-3498
Practice Address - Fax:718-963-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2139542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology